益气温阳活血方对慢性心力衰竭心室重塑患者凋亡相关因子的影响研究

目的:探讨益气温阳活血方对慢性心力衰竭(chronic heart failure,CHF)心室重塑患者凋亡相关因子的影响。方法:将CHF患者122例随机分为治疗组64例和对照组58例,2组均按CHF治疗指南给予常规治疗,治疗组加服用益气温阳活血方。2组治疗前后分别以心脏超声检查患者左心室收缩末径(LVESD)、舒张末径(LVEDD)和左心室射血分数(LVEF),采用酶联免疫吸附法测定患者血浆凋亡相关因子Fas、Fas配体(Fas L)、B细胞淋巴瘤(Bax)/白血病-2(Bcl-2)、半胱胺酸天冬氨酸酶-3(cas Pase-3)和半胱胺酸天冬氨酸酶-9(cas Pase-9)的含量。结果:治疗3个月后,与治疗前比较,两组LVESD、LVEDD以及Fas、Fas L、Bax、caspase-3和caspase-9含量降低,而LVEF、Bcl-2含量明显升高,差异均有统计学意义(P0.05)。结论:益气温阳活血方通过影响Fas、Fas L、Bax、Bcl-2、caspase-3和caspase-9含量抑制CHF患者心室重塑,改善心脏功能。     

卡维地洛治疗充血性心力衰竭66例临床分析

目的:观察卡维地洛治疗充血性心力衰竭的疗效.方法:选择充血性心力衰竭(CHF)患者66例,随机分为常规治疗组(33例)和卡维地洛治疗组(33例),后者在常规抗心衰治疗基础上加用卡维地洛,两组治疗前和治疗6个月均使用超声心动图分别测定左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)和左心室射血分数(LVEF),并观察6min步行距离和心率变化.结果:CHF患者应用卡维地洛治疗后,LVEDD、LVESD和LVEF的改善均优于常规治疗组(P＜0.01),6min步行距离增加较常规治疗组更为显著(P＜0.01)、心率有所下降.结论:在心衰常规治疗基础上加用卡维地洛治疗CHF,可明显改善心功能.     

应用卡维地洛、比索洛尔和常规方法治疗慢性心力衰竭临床疗效比较

目的比较应用卡维地洛、比索洛尔和常规方法治疗慢性心力衰竭(CHF)的疗效。方法92例CHF患者分为卡维地洛组(34例)、比索洛尔组(38例)和常规组(20例)。常规组应用血管紧张素转换酶抑制剂、利尿剂和洋地黄制剂,卡维地洛组和比索洛尔组在常规治疗基础上分别加用卡维地洛和比索洛尔。随访半年,分别测量治疗前后心率、血压6、min步行试验距离,并用超声心动图测定心功能进行疗效观察。结果1)卡维地洛组和比索洛尔组心率、血压和心肌耗氧量均较常规组明显降低,6min步行试验距离增加,但差异无统计学意义。2)卡维地洛组和比索洛尔组左心室舒张末径(LVEDD)和左心室收缩末径(LVESD)显著低于常规组,左心室射血分数(LVEF)显著高于常规组,且卡维地洛组LVESD较比索洛尔组明显减小。结论卡维地洛和比索洛尔通过β1受体阻滞等作用,逆转左心室重构,在改善CHF患者心功能方面作用相似。     

卡维地洛对慢性心力衰竭患者血清脂联素表达及心功能的影响

目的探讨卡维地洛对慢性心力衰竭(CHF)患者血清脂联素(APN)、有关心衰标志物表达及心功能的影响。方法选择行常规治疗的60例CHF患者为对照组,同期60例加用卡维地洛治疗的CHF患者为实验组,疗程6个月。观察治疗前后患者的心功能分级、超声心动图下左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)和左心室射血分数(LVEF)及酶联免疫法测定的血清APN、氨基末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白T(cTnT)水平变化。结果心衰患者的血清APN、NT-proBNP、cTnT水平随着NYHA分级增加而明显升高。治疗6个月后,实验组和对照组治疗总有效率分别为91.7%和73.3%,差异有统计学意义(P0.01)。治疗后两组患者LVEDD、LVESD均缩小,LVEF明显提高。治疗后,两组血清APN、NT-proBNP、cTnT水平均降低(P0.05),且实验组以上指标较对照组下降更为显著,差异有统计学意义(P0.05)。结论卡维地洛可以显著降低慢性心力衰竭患者的血清APN、NT-proBNP、cTnT水平,明显改善心功能。     

卡维地洛对老年充血性心力衰竭患者心功能和细胞因子的影响

目的:观察卡维地洛对老年充血性心力衰竭(CHF)患者心功能的改善和对细胞因子的影响.方法:老年CHF患者45例随机分为心力衰竭常规治疗组(n=22)和卡维地洛治疗组(n=23),后者在常规抗心力衰竭治疗基础上加用卡维地洛,疗程6个月.两组治疗前和治疗3个月、6个月分别测定左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)和6 min步行距离.测定健康对照组(n=30)和两组心衰患者治疗前和治疗6个月血浆肿瘤坏死因子(TNF-α)、白细胞介素(IL)-1β和IL-6的浓度.结果:老年CHF患者用卡维地洛治疗6个月后,LVEDD、LVESD、LVEF和6min步行距离的改善均优于常规治疗组(P＜0.01,P＜0.05).心衰患者3种细胞因子血浆浓度均高于对照组(P＜0.001),卡维地洛治疗后细胞因子的下降明显优于常规抗心力衰竭治疗(P＜0.01).结论:卡维地洛可明显改善老年CHF患者心功能,提高运动耐量,改善左室重构,降低细胞因子TNF、IL-1和IL-6的浓度.     

卡维地洛与美托洛尔治疗慢性充血性心力衰竭效果比较

目的:比较卡维地洛与美托洛尔治疗慢性充血性心力衰竭(CHF)的治疗效果。方法:将74例慢性CHF患者,随机分为卡维地洛组(观察组)37例 和美托洛尔组(对照组)37例,观察2组患者治疗后的心功能状态,以及左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)和左心室舒张末期内径(LVEDD)等变化。结果:2组患者心功能均明显的改善,而且对于血浆细胞因子以及逆转心脏的重塑也起到了良好的作用。观察组患者治疗后LVEF较对照组明显升高(P<0.01),LVEDD与LVESD下降程度均高于对照组(P<0.05和P<0.01)。结论:卡维地洛与美托洛尔均可有效改善慢性CHF患者的各种临床症状以及心功能,而且卡维地洛的效果更加明显。     

沙库巴曲缬沙坦联用法舒地尔治疗冠心病心力衰竭的临床观察

目的 观察沙库巴曲缬沙坦联用法舒地尔治疗冠心病心力衰竭的临床效果。方法 选取于延安市人民医院心内科住院的冠心病心力衰竭患者80例,随机分成对照组和观察组各40例,均接受常规治疗,对照组采用沙库巴曲缬沙坦治疗,观察组采用沙库巴曲缬沙坦联用法舒地尔,比较两组患者的临床疗效、治疗前后左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)、血浆脑钠肽(NT-proBNP)、血清可溶性细胞间黏附分子-1(sICAM-1)和血浆内皮微粒(EMPs)水平及不良反应。结果 观察组总有效率高于对照组,差异有统计学意义(P＜0.05)。治疗前,两组患者LVEDD、LVESD、LVEF、NT-proBNP、EMPs、sICAM-1对比,差异无统计学意义(P＞0.05);治疗后,两组患者LVEDD、LVESD、LVEF、NT-proBNP、EMPs、sICAM-1均较本组治疗前明显改善,且观察组改善更显著,差异有统计学意义(P＜0.05)。两组患者不良反应发生率低。结论 沙库巴曲缬沙坦联用法舒地尔治疗冠心病心力衰竭的临床效果显著,可抑制心肌重塑,降低炎症因子水平,改善心功能,安全性高。     

辛伐他汀对慢性心力衰竭兔心肌细胞凋亡的影响

目的探讨辛伐他汀对慢性心力衰竭(CHF)兔心肌细胞凋亡的影响及其机制。方法将36只新西兰雄性大耳兔随机分为正常对照组、CHF组和辛伐他汀组,每组12只。CHF组和辛伐他汀组兔经耳缘静脉注射注射用盐酸多柔比星1. 5 mg·kg~(-1),每周1次,连续10周,注射完成后再观察2周;正常对照组兔经耳缘静脉注射生理盐水;辛伐他汀组兔在首次注射多柔比星时开始给予辛伐他汀1. 5 mg·kg~(-1)灌胃,每日1次,连续12周。12周后,3组兔行超声心动图检查,分别测量左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左心室短轴缩短率(LVFS)及左心室射血分数(LVEF)。心脏超声心动图检查后,兔颈动脉取血5 mL,采用酶联免疫吸附试验检测血清可溶性Fas(s Fas)水平。采用空气栓塞法处死兔,游离左心室心肌,采用末端脱氧核苷酰基转移酶介导性d UTP切口末端标记法检测心肌细胞凋亡情况,并计算细胞凋亡指数;采用免疫组织化学法检测心肌细胞中p53蛋白表达,并计算p53蛋白阳性表达率。结果辛伐他汀组和CHF组兔LVESD、LVEDD大于正常对照组(P <0. 05),LVEF、LVFS显著低于正常对照组(P <0. 05);辛伐他汀组兔LVESD、LVEDD小于CHF组(P <0. 05),LVEF、LVFS高于CHF组(P <0. 05)。正常对照组、CHF组和辛伐他汀组兔血清s Fas水平分别为(8. 42±0. 14)、(11. 7±0. 55)、(9. 43±0. 35) mg·L~(-1),CHF组和辛伐他汀组兔血清s Fas水平高于正常对照组(P <0. 05),辛伐他汀组兔血清s Fas水平低于CHF组(P <0. 05)。正常对照组、CHF组和辛伐他汀组兔心肌细胞凋亡指数分别为1. 08±0. 12、16. 13±1. 17、4. 86±0. 11,CHF组和辛伐他汀组兔心肌细胞凋亡指数高于正常对照组(P <0. 05),辛伐他汀组兔心肌细胞凋亡指数低于CHF组(P <0. 05)。正常对照组、CHF组和辛伐他汀组兔心肌细胞p53蛋白阳性表达率分别为18. 62±0. 41、45. 39±0. 68、33. 17±0. 52,CHF组和辛伐他汀组兔心肌细胞p53蛋白阳性表达率高于正常对照组(P <0. 05),辛伐他汀组兔心肌细胞p53蛋白阳性表达率低于CHF组(P <0. 05)。结论辛伐他汀可以显著改善CHF大鼠的心功能,抑制心室重构,其机制可能与其抑制Fas/Fas L信号系统及心肌细胞凋亡有关。     

N末端原脑利钠肽测定在慢性心力衰竭患者中的临床应用

目的:探讨N末端原脑利钠肽(NT-pro-BNP)对慢性心力衰竭(CHF)患者的临床诊断价值.方法:2008年9月至2010年3月我院心血管内科收治的符合美国纽约心脏病协会心功能分级的CHF患者115例(心力衰竭组),另选择同期39例非心力衰竭的心内科病人作为对照组.比较两组血浆NT-pro-BNP水平、左心室射血分数(LVEF)和左心室舒张末期内径(LVEDD);比较不同心功能分级CHF患者血浆NT-pro-BNP水平、LVEDD和LVEF的差别;分析血浆NT-pro-BNP水平与LVEDD、LVEF的相关性.结果:与对照组相比,心力衰竭组血浆NT-pro-BNP水平、LVEDD明显升高(P＜0.05),LVEF明显降低(P＜0.01);与心功能Ⅱ级、心功能Ⅲ级的CHF患者比较,心功能Ⅳ级的CHF患者血浆NT-pro-BNP水平及LVEDD明显升高(P＜0.01),LVEF明显降低(P＜0.01);CHF患者血浆NT-pro-BNP水平与LVEDD呈正相关(P＜0.01),与LVEF呈负相关(P＜0.01).结论:血浆NT-pro-BNP水平可以作为判断CHF的一个可靠指标,同时能够较好地反映左室功能状态,并有助于判断CHF的严重程度.     

缬沙坦治疗合并心力衰竭的高血压患者的临床效果研究

目的探讨缬沙坦治疗合并心力衰竭的高血压患者的临床效果。方法选取我院2014年10月至2016年9月期间我院收治的合并心力衰竭的高血压患者86例,随机分为治疗组和对照组,对照组给予患者疾病的常规治疗,治疗组在对照组基础上使用缬沙坦治疗。比较两组患者治疗前后的心率、舒张压和收缩压、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)和左心室收缩末期内径(LVESD),以及6min步行距离。结果治疗后,两组患者心率、血压水平、LVEF、LVEDD和LVESD以及6min步行距离均不同程度改善(P0.05),与对照组比较,治疗组心率、血压水平、LVEF、LVEDD和LVESD以及6min步行距离改善情况更显著(P0.05)。结论缬沙坦治疗合并心力衰竭的高血压患者临床效果显著,能够明显改善患者的心功能,降低血压和心率。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.